Wednesday, July 29, 2009 – Day 5

PHNOM PENH HOTEL

Secretary of State being interviewed above.































































**NOTE: NAMES HAVE BEEN CHANGED**

Sorry - the pics aren't turning out well. Will try to be better next time.

I get up at 6 AM, way before my alarm goes off, supposedly at 6:45 AM. In fact, I haven’t heard my alarm at all this week – the birds wake me up. I finally opened my curtains and peeked outside the window. There are rooftops and windows so close that I’m sure whoever was in those rooms could see me. Beyond the rooftops, I see the first glimmer of sunrise and this is the first time in a long time that I’ve seen this. I begin getting ready slowly – taking an unusually long hour and by the time I’m through, the heat of the sun is on my skin in the bathroom through the decorated window. I look outside my bedroom window again and the sun has moved 30 degrees higher.

I go to work and shortly thereafter, Nemo rushes into a WHO van with me taking 2 steps for his every 1 step. (I forgot to mention in the previous day’s discussion with Nemo why there is all this money spent on influenza (mortality rate for seasonal flu is less than 2%) when there are so many other dire issues in Cambodia like dengue fever, measles, etc. His rationale is that this influenza work isn’t just for influenza, it’s to set up an actual working surveillance and public health system in Cambodia, a country of limited resources. When this system is functioning, other parameters and burdens of disease can be alleviated, hopefully. The first of many ethical discussions.)

He is a tall guy with a commanding presence and walks with purpose. The driver takes us to Phnom Penh Hotel, where there is a workshop today. I am dressed in a pink polo and dress pants with my sparkly, jeweled silver flats – I thought there would be walking and my black dress shoes already hurt after 1 day of use. We arrive at the hotel and it is breathtakingly beautiful. There are at least 4 large stone lions flanking a fountain with a large rotating ball outside the hotel. The door of the van is opened and I hop down. The front glass doors open before me by men dressed in red uniforms and before I could take in the elegant lobby, Nemo is five steps ahead. We arrive at the elevator and we go up. The clear glass elevator is decorated with stars on the ceiling and I wonder if they light up at night. After going up 1 floor, the blue wall behind the translucent glass elevator gives way to the shimmery blue of the Olympic-sized pool with elegant lounge chairs. This is a 4-star hotel I learn later…

I enter the meeting room and I am taken aback by the long conference style table with lots of men in military-like uniforms and the large sign at the front with tables and basically lots of pomp and circumstance. I see the WHO Representative, Dr. Lucky Charms, (head honcho of the WHO Cambodia office) sitting at the front with a few other Cambodian men. So this “workshop” is formally called “Workshop on Health Quarantine Measures Review to Prevent & Control Pandemic Influenza A (H1N1).” I’ve never attended a workshop with water glasses, water bottles, men in uniform, press, cameras, and suits. I thought workshops meant hands-on activities, small groups, lots of coffee to get through the boring ordeal, etc. And then I wonder if I should’ve worn a suit. So Dr. Lucky Charms and the other Cambodian men sit at the table facing the room and each make ceremonial speeches about how important this is. Marlin translates for Dr. Lucky Charms and there is a part where Dr. Lucky Charms says something not on the paper and Nora fumbles – it was a bit humorous but I could tell Marlin felt flustered and anxious about it afterwards. I try to comfort him by saying that he did a great job b/c the paper was written in English, not Khmer and translating on the spot is hard. So it turns out that this event was more formal than I thought and the people sitting by Dr. Lucky Charms are kind of important. Nora kindly assures me that my polo and dress pants are fine, though I feel like I should wear a suit (but didn’t pack one b/c I didn’t expect meetings with Excellencies of the State).

From left to right in the picture, it is someone from the National Committee for Disaster Management, His Excellency Secretary of State for Flight and Aviation, His Excellency Secretary of State for Health, Dr. Lucky Charms, and the head of the Communicable Disease Control Department of the Ministry of Health (MoH). Marlin tells me all this and informs me that the people in uniform and sparkly buttons are people from customs and border patrol. I just smile and do the Asian nod (short bob that shows deference or respect). Everyone (I think there was just 1 woman who was a reporter and the rest were all men) stare at me like I’m a zoo animal or something. I think being Chinese/Korean-looking in this country is quite peculiar in that people try to guess what I am all the time. When I say I’m from America, they respond with “no, where are you FROM?” and to that I reply, “my PARENTS are from China.” So the speeches go on and there is a group photo – such an Asian thing. The Chinese are all for group photos, I think the Chinese Communist Party spend half their time posing for pics. I know so b/c I spent 45 minutes getting into formation and 1+ hour waiting in my spot in 3.5” heels waiting for the 3rd-highest ranking party member to come out, make an elaborate speech in the thick Beijing accent, none of which I understand, and then we pose for a million photographs. I am motioned to join so I am in this ginormous group photo – too bad I didn’t take a pic with my camera.

Break time – I receive a phone call via vibrations when I thought my phone was on silent. Turns out I worked an older cell phone in Spanish than this Nokia phone in English. Hello? The faint female voice on the other side says, “…blah blah Namru blah blah. Dr. Waters would like to speak with you.” I get excited……

A couple months ago, I took a tour of the Holocaust Museum to learn more about the medical experiments/side of the genocide. The person organizing this was Dr. Navy, a MD/MPH, who also teaches at GW med school and works for the Navy. This was the time of the H1N1 outbreak in April and his phone was ringing off the hook and he was glad to take a break from it all to tour the museum. I mention that I’m interning in Cambodia doing avian influenza work and he immediately brightens up and says “excellent”, which was quite a shocker b/c he didn’t seem like the type of man to compliment often. He gave me his card and said that I should take a tour of the facilities in Cambodia and he’ll put me in touch with people.

Fast-forward to this week. I emailed Dr. Navy after packing his business card last minute on Monday and he responds immediately with contacts in Indonesia. I am mistaken for a doctor and people are surprised why my visit was unknown or unannounced to them in the corresponding emails. I correct them and say I’m a med student and the chain of emails and forwards continue. I finally get the email from the Director of NAMRU-2 of Cambodia and he is Dr. Water, who called me.

NAMRU is the Department of Defense’s US Naval Medical Research Unit, created during WWII to study infectious diseases of military significance. It makes sense b/c we have stations and military personnel in Asia. NAMRU-2 is based in Jakarta, Indonesia and they also have lab facilities in Phnom Penh. I am using their febrile illness surveillance data to include in my report. I think I might meet Dr. Water at the meeting this Friday but we schedule a tour for next Thursday for myself and Conchy, who expressed interest in going.

I find Nemo and tell him the news – apparently, they know each other but I’m glad that I didn’t ask through Nemo and found Dr. Water through my own contacts, just one less thing for him to do for me as he’s always rushing around. I drink some tea, sans sugar, and find Marlin by the fruit and mini French croissants table. All around are the men staring and trying to figure out who I am and what I’m doing there. The fruit are large pieces, cut like crinkle-cut fries, like how Chinese restaurants cut their carrots. I see pineapple and orange melon and dragon fruit (not tasty to me). Then I see papaya, which I never realized was bright orange/red and I decide it’s not that good either. I make small chit-chat with Marlin, who reminds me much of a Hong Kong guy b/c his hair is long, he wears black square glasses, his pants are tighter than I’m used to seeing in the US (and only see in Asia), and his affect/way of talking is hurried and accented. This is my first impression of him – I thought he was annoyed by having to explain ILI to me and impatient with my question about Tamiflu (I am slow sometimes). Today I realize that he is super nice and whatever data I need, he tries to get it for me and even offers help if I need it in the city - he even gave his number in case something happens. Some men smoked in hallways of this hotel and I remember that this is my first time experiencing cigarette smoke in this country – they’ve come such a long way. I met another global health leader of Duke University earlier this semester who actually worked on the tobacco campaign in Cambodia to eliminate smoking in temples, monasteries, and some public areas. He worked to increase awareness of the dangers of cigarettes and fought against big companies like Phillip Morris. He is such a modest man and only after talking to him do I realize how much he has accomplished.

End of break – Nemo gives a presentation – see pics. The International Health Regulations of 2005 (effective June 15, 2007) is repeated often b/c this document legally binds all member states to collaborate on ALL public health issues. There are confirmed cases of H1N1 (by lab) in over 150 countries – I think about how many more people are infected but not showing clinical symptoms. Two more long presentations and Q&A session and it’s lunchtime! I meet Dr. Soccer on the way out – he’s the head of the Communicable Disease Control Dpmt of the MoH. I also met Dr. Anchor – Deputy Director of MoH and then someone else I’ll see on Friday, who works at the Institute Pasteur of Cambodia in Virology (typing all the samples).

We rush down because we need to get back to the office, but we have time for lunch. I give my blue lunch coupon to the hotel staff and it is buffet-style. There are at least 7 different stations with international cuisines: sushi, Indian, pasta, salads galore, pate… double-take (pate??!!), bread, etc. People are the same with lines here as they are with driving on the road – no concept of it. There is no line to get in for your turn at each serving plate and there is no ladies first.

I eat a plate of Indian food and another of Caesar salad and a bit of pork pate with French bread. Their French bread is amazing here – one good thing about the French colonization. Nemo says we have time for dessert. I go check it out and have never seen so many colors in my life! I try a teeny bit of strawberry mousse, brownie, kiwi mousse, carrot cake, and my plate is half dotted with these tiny pastries when I see this man putting all sorts of stuff from a station of 15 bowls into his 1 small bowl. I stare and I guess he notices because he says “this is called 12-dessert. Put a little bit of everything in this bowl.” I thank him and wait until he’s done. I grab a little bit of this green worm looking thing, a couple of hot pink red plums, a thing of black jelly, dried sweet melon, some sugar syrup, some ice with water, and coconut cream. It doesn’t look that great, but when in Rome…. I bring the plate back to the table and Nemo says “you have a bit of a sweet tooth don’t you.” Marlin is chowing on fruit and he says "I don’t eat dessert – too sweet. I just eat fruit." I take a bite of something and he’s right – it is like sugar formed into a soft mousse with colorful dye. The 12-dessert delight is also not that appetizing so I leave a plate of rainbow desserts to waste.

We leave in Marlin’s silver Honda CRV, which is similar to the car I was thinking about getting, except his costs $7000 and he’s astounded that the car I was looking at would be $22,000 knocked down to $19,000. He bought an older version. He navigates the road well and in the car, Nemo and Marlin chit chat as I listen. They talk about good coffee shops in Phnom Penh.
Nemo lists some coffee shops and Marlin says, “Where is that? No one here goes by street names. We only know landmarks and then work from that.” AH-HAH!!! That’s why every taxi, tuk-tuk, moto, and cyclo driver never find the actual address I need. I should give them landmarks next time… like a true PP native.

We arrive back at the WHO office and there is a staff meeting with everyone in the WHO office. That meeting will be posted later as there is info that can’t be released yet publicly.

I decide to forgo the fried rice for dinner and find a cute café recommended by Belle, who is in Scotland now for a wedding. It’s around the corner but I get lost, but I didn’t know I would be lost until Buddha rescued me. Bruce tells me to make a right and the Garden Café 2 is on my right. Buddha tells me to make a left and go down 3 blocks. I get out the guidebook and it shows a left. So I make a left at the end of my street and hear “moto?” and “tuk-tuk?” and I keep walking and the streets are dark. The only light comes from the occasional house light or street sign pointing to a restaurant close by. “Moto?” No, I shake my head without turning behind. I notice it trailing slowly behind me and I pick up the pace. “Moto?” “No,” I said firmly. I finally turn and see Buddha on his black moto. “Buddha!!” I feel abashed that I was so firm with him but thought he was a moto driver and freaked out when he trailed behind. He apologized for sending me the wrong way and said that Ms. Ray, the housekeeper, told him the GC had moved to where Bruce said it was. So I get on his moto and he drives me to GC2. I was so relieved b/c the area I was heading to was pitch dark. The man is so endearing – I wish I could take him back to the US with me! And his adorable baby and family too. I was so touched that he came out to get me and was concerned about my safety.

I walk into the front of the restaurant and all heads swiveled. Here, I’m not sure if you just sit down or if you wait for someone to motion for you where to sit. I sit down and pore over the menu of select wines (no Riesling), 2 pages of breakfasts, 2 pages of salads, sandwiches, soups, Mexican food, Asian food, desserts, etc. I take forever to decide on a sweet & sour mixed vegetable with chicken dish. And then after looking at other tables, I ordered water, not from a bottle. It comes out in a pretty pitcher and it tastes quite good. Good thing I have my Hep A shot and know the treatment for cholera… it’s all a matter of getting the treatment here somehow… I write postcards while I wait for the food and it comes out in two plates. One plate of neat pyramidal-shaped rice and another of the main dish. The main dish has carrots, celery, cucumber, chicken, peas, pineapple, etc. I put the S&S dish on top of the rice and try it. It is quite good and I end up taking half to go. Expecting a box, I was quite confused when my leftovers came in a ziplock bag. The waiter asks, “where are you from?” I say America. He responds, “you look so Asian.” (Yes, we Asians live in other countries. We do not just live within our home countries. He means well but I wonder why my race matters so much every time I’m abroad). I pay $6 plus tip for dinner and walk next door to a mini souvenir shop with very overpriced items. I come home and figure that was a good choice b/c I can add the well-seasoned dish to my fried rice to make it more palatable.